Smudge: day 3 at home

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Hendrick Cuddleclaw said:
Why do vets always seem so focused on the pre-shot number far as the dose goes. It's not about that! It's about how LOW the dose takes him when it is hitting hardest.

Regardless, I am happy to hear the vet wants to drop the dose. As Suzanne said, so much better to start a little lower and increase as needed if the numbers tell you so.
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I agree with you. I am so conflicted on what to do for him. Trying to follow my gut and also follow their medical advice is hard.
 
Either see above the link on managing low numbers that Sienne sent, or here, I have copied out a portion of it. You are supposed to get two consecutive tests in with stable or rising numbers. Personally, I would feel better if you could get a test in 30 minutes from the last test. See below:

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
 
Suzanne & Darcy said:
Either see above the link on managing low numbers that Sienne sent, or here, I have copied out a portion of it. You are supposed to get two consecutive tests in with stable or rising numbers. Personally, I would feel better if you could get a test in 30 minutes from the last test. See below:

If your cat is testing in low numbers and you are not getting a quick response to your post, there are several things you need to do. (Low numbers are under 50mg/dL or 2.8 mmol/L.)
  • Depending on how carbohydrate sensitive your cat is, feed approximately a teaspoon or less of gravy from high carb food or high carb food only. (If you have a cat with GI issues, using a couple of drops of syrup plus low carb food is an alternative.)
  • Test again in 15 – 20 min. Depending on the numbers, give more HC food.
  • Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests. Continue to feed in small amounts to keep numbers in a safe range.
  • Test in 30 - 40 min. and repeat the test and feed process until there are 2 consecutive tests where numbers are stable or rising.
  • Test in an hour and follow the same steps.
DO NOT become complacent. If numbers have risen after one or two tests, it’s important to continue testing. Numbers may bobble up and down as the HC food and/or Karo wear off. DO NOT get one test where your cat has risen from low numbers into the 50s and go to sleep or leave the house. You are putting your cat in a risky situation. When in doubt, leave HC food out.
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He is not tolerating the ear pricks well with the rush to test frequently, I've had to purrito him every time and he is crying out. I am concerned it will make him combative for future testing. Because of this, considering the Freestyle Libre 3 (also because I've already spent $20 worth on AT3 strips just today).
 
Hendrick Cuddleclaw said:
Why do vets always seem so focused on the pre-shot number far as the dose goes. It's not about that! It's about how LOW the dose takes him when it is hitting hardest.

Regardless, I am happy to hear the vet wants to drop the dose. As Suzanne said, so much better to start a little lower and increase as needed if the numbers tell you so.
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Yeah, Kyle, I really think that most vets especially have no experience with using depot insulins. They are thinking about it more like vetsulin or ProZinc or even the short acting insulins. I don’t know that they understand how the insulin depot works in reality. I am sure that they have read about how it’s supposed to work, but it’s certainly not the same as managing a diabetic cat day to day.
 
Suzanne & Darcy said:
Yeah, Kyle, I really think that most vets especially have no experience with using depot insulins. They are thinking about it more like vetsulin or ProZinc or even the short acting insulins. I don’t know that they understand how the insulin depot works in reality. I am sure that they have read about how it’s supposed to work, but it’s certainly not the same as managing a diabetic cat day to day.
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The vet he first saw (who I spoke to today) *did say* she typically uses Vetsulin, but I requested the Lantus. You may be right. I don't totally understand the insulin depot myself quite yet (getting there).
 
Suzanne & Darcy said:
Repeat the above steps every 15 – 20 min. until your cat tests in the 50 mg/dL (2.8 mmol/L) or above range for 2 consecutive tests.
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Alli — just remember that all references to 50 mg/dl refer to a human meter, so you’ll want to be above 68 on the AT3 (or round up to 70 if that’s easier to remember).
Suzanne & Darcy said:
Yeah, Kyle, I really think that most vets especially have no experience with using depot insulins. They are thinking about it more like vetsulin or ProZinc or even the short acting insulins.
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I wonder about this too — many seem much more familiar with the concept of an “in and out” type insulin. Maybe they see more diabetic dogs??
 
allicatmeow said:
He is not tolerating the ear pricks well with the rush to test frequently, I've had to purrito him every time and he is crying out. I am concerned it will make him combative for future testing. Because of this, considering the Freestyle Libre 3 (also because I've already spent $20 worth on AT3 strips just today).
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I’m sorry. This is not a great day for Smudge from a testing standpoint. I am concerned that he rose to 109 with the help of HC, but it’s still early in the cycle — before what we are guessing is his nadir timeframe (with limited data.). I don’t even like Libre sensors, but right now I wish he had one on to make things easier on you both. Are you getting a human meter with cheaper strips?
 
Suzanne & Darcy said:
I’m sorry. This is not a great day for Smudge from a testing standpoint. I am concerned that he rose to 109 with the help of HC, but it’s still early in the cycle — before what we are guessing is his nadir timeframe (with limited data.). I don’t even like Libre sensors, but right now I wish he had one on to make things easier on you both. Are you getting a human meter with cheaper strips?
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I have the human meter (ReliOn Blu) but it requires more blood than the AT3 and I am barely getting any as it is, so I can't use it without an even worse scenario of multiple pricks and errors.
 
I have to leave for a dental appointment now. Test in 30 from the last test after you gave HC (or whatever you gave him). Post number here. Keep following the managing low numbers sticky note. I will check when I get there about 2 o’clock. Others may be around as well.
 
Hendrick Cuddleclaw said:
+57 @ +7, yikes

more HC, honey on the gums again maybe

hopefully at this point the insulin has peaked. The vaseline is key if you weren't doing it before, it will be a game changer for you.
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Sorry I've gone silent just dealing with this and calling the vet again. She said what you did, that it should have peaked by +7 latest, so we should be on the upswing. Feeding lots of HC and his chicken treats, still eating well. He is tired, but not lethargic (prob from me waking him for testing so much).
 
If his ears look sore
Get pure coconut oil
I have read that many members use pure coconut oil, I have copied this from one of the members posts
just make sure the only ingredient is coconut oil (mine is solid at room temp and I would take an itty bitty dab and rub on his ears)
It seemed to help with the healing
You might be able to get it at a health food store or just Google pure coconut oil
 
allicatmeow said:
Sorry I've gone silent just dealing with this and calling the vet again. She said what you did, that it should have peaked by +7 latest, so we should be on the upswing. Feeding lots of HC and his chicken treats, still eating well. He is tired, but not lethargic (prob from me waking him for testing so much).
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SHOULD have peaked. But you never really know, every cat is different.

I am interested to see what PMPS brings.
 
Hendrick Cuddleclaw said:
how is he doing?
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I wasn't able to get another reading, he is very much "over it". He is still eating, peed. I found a kicker stick my cat never liked and he played with that for about 5 mins and went to sleep.

I have my vet tech friend coming within the hour to help me learn to lance better, so I can torture him less.

Diane Tyler's Mom said:
If his ears look sore
Get pure coconut oil
I have read that many members use pure coconut oil, I have copied this from one of the members posts
just make sure the only ingredient is coconut oil (mine is solid at room temp and I would take an itty bitty dab and rub on his ears)
It seemed to help with the healing
You might be able to get it at a health food store or just Google pure coconut oil
Click to expand...
Oh I have some of that in my cabinet! I will use it and/or the Vaseline tonight. Thank you. ❤️
 
I am SO sorry we didnt mention the vaseline before. omg

It is #$%^ KEY. I never got a droplet without it. Just a smidge on the poke spot before you poke.

also, the angle of the poke helps. You want to make sure the lancet is angled with the pointy part down, at about a 45 degree angle of approach.
 
Hendrick Cuddleclaw said:
I am SO sorry we didnt mention the vaseline before. omg

It is #$%^ KEY. I never got a droplet without it. Just a smidge on the poke spot before you poke.

also, the angle of the poke helps. You want to make sure the lancet is angled with the pointy part down, at about a 45 degree angle of approach.
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I read about it, but I didn't realize how well it worked I guess. The videos never show it, so I didn't think it was so $%^ KEY. ;)

I feel so bad because he cries now with every poke.
 
Yeah I don't explain it, but at the 10-12 second mark of my video, that is what I am doing. I am dabbing Vaseline on the target pokey spot. :(


I have a tiny dab on my index finger and if you look closely, I smear it on with a few repeated strokes

 
I checked in a couple of times and didn’t see any messages. I just now got home and see all this! I’m glad he’s doing okay. See what I mean about the BG dropping back down. Now, I wonder if the bet would like to cut the dose even further given all of this new information? If he’s not producing ketones - he wasn’t before. Don’t know if you caught anything today.
 
Okay. I am not being critical, but if things were optimal and your testing was going well, you would have fed and then tested 30 minutes after the 72 to make sure he was stable or rising. If not, you would give more HC and then test another 20 minutes. And keep doing this until you have the two consecutive stable or rising numbers. And you keep testing for two hours after HC is given. Only exception I would make to that (which I can think of right now) is of the cat starts skyrocketing into high numbers.
 
Suzanne & Darcy said:
Did your friend come to help show you how to test.

and bet said to shoot 2 units? I am just glad it’s a lower dose. I hope he will do well on this dose. Be sure to get a +2 even though he is probably beginning a bounce.
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Yes she did. She basically told me I need to "lance with conviction" because I am being too gentle and that's causing not enough blood. She showed me a few areas that she always has success with, so here's hoping.

Vet said 2U or 3U tonight, whatever I was comfortable with based on his number. I decided on 2U for two reasons. First, because he was not back up over 400 and he hadn't had HC for quite a while. Second, because of the dip to the 50s today, I would rather he hover not quiiiiite low enough than drop so drastically again. It's just what my gut told me after being with him all day.

We also used the blood ketone monitor, he does not have any in his blood. :)
 
allicatmeow said:
Yes she did. She basically told me I need to "lance with conviction" because I am being too gentle and that's causing not enough blood.
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It’s really common to hesitate to poke firmly. Good job on getting blood at all; a few tweaks to the process and I’m sure you’ll be a pro before you know it.

allicatmeow said:
Vet said 2U or 3U tonight, whatever I was comfortable with based on his number. I decided on 2U for two reasons. First, because he was not back up over 400 and he hadn't had HC for quite a while. Second, because of the dip to the 50s today, I would rather he hover not quiiiiite low enough than drop so drastically again. It's just what my gut told me after being with him all day.
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For what it’s worth, I’d probably have gone with 2u as well. I’ve always been more comfortable working the dose up from below rather than being aggressive with dosing and dealing with the drama that comes with trying to bring up scary low BGs. Plus, you didn’t arrive at 4u slowly and methodically, so it’s very possible that it’s way too much, not just a little too much. Or not. Only time and data will tell. The only caveat is the DKA history, which is an important consideration. However, a negative ketone test is great news and the fact that he’s eating well is also important.

Lantus likes consistency, so I’d stick with the 2u dose you’ve chosen to see what it’ll do, even if you see some higher numbers in the short term (he might bounce from todays lows, but just ride it out and don’t be tempted to increase; chasing numbers rarely works). Of course if at any point he drops under 90 again, another dose reduction is warranted. And I’d keep checking for ketones.

Again, good job today. It’s a lot to handle so early in the game but you’re doing all the right things. It will get easier. :)
 
By the way, today’s 57 is lime green on the AT (not sure why it’s not showing that way; you might need to manually color the cell).

Also, with the drop at PM +2, you might want to get another test in before bed. The 4u depot is still at play so can impact the numbers well into this cycle (or further).
 
Since you've dropped the dose so much, and he's very recently out of DKA, please try to get a ketones test when possible. I'm not saying it was wrong to drop the dose, but when DKA is very recent, we try to keep the dose as high as safely possible. Too little insulin is part of the formula for DKA. So you just need to keep a close eye on ketones.
 
JL and Chip said:
For what it’s worth, I’d probably have gone with 2u as well. I’ve always been more comfortable working the dose up from below rather than being aggressive with dosing and dealing with the drama that comes with trying to bring up scary low BGs. Plus, you didn’t arrive at 4u slowly and methodically, so it’s very possible that it’s way too much, not just a little too much. Or not. Only time and data will tell. The only caveat is the DKA history, which is an important consideration. However, a negative ketone test is great news and the fact that he’s eating well is also important.

Lantus likes consistency, so I’d stick with the 2u dose you’ve chosen to see what it’ll do, even if you see some higher numbers in the short term (he might bounce from todays lows, but just ride it out and don’t be tempted to increase; chasing numbers rarely works). Of course if at any point he drops under 90 again, another dose reduction is warranted. And I’d keep checking for ketones.

Again, good job today. It’s a lot to handle so early in the game but you’re doing all the right things. It will get easier. :)
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Thank you so much. It feels relieving in a way that an experienced member would've chose 2U. I just felt like I needed to go with my gut for him and with reading so many threads of other people asking for help and seeing how few started as high as Smudge and how common 2U seems to be, I went with it.

JL and Chip said:
By the way, today’s 57 is lime green on the AT (not sure why it’s not showing that way; you might need to manually color the cell).

Also, with the drop at PM +2, you might want to get another test in before bed. The 4u depot is still at play so can impact the numbers well into this cycle (or further).
Click to expand...

I'm having trouble on mobile with colors, so I'll try to fix it on my computer this morning when I enter the rest of his morning stats. I fell asleep very quickly last night from exhaustion and I knew that I would, so I did not get a +4, but I left him plenty of food overnight at the direction of my vet because of the low numbers and adjustment. When I got up this morning he had cleaned his bowl overnight and was ready for more, but he will wait until another 2 hours so I could get a fasted AMPS.

Wendy&Neko said:
Since you've dropped the dose so much, and he's very recently out of DKA, please try to get a ketones test when possible. I'm not saying it was wrong to drop the dose, but when DKA is very recent, we try to keep the dose as high as safely possible. Too little insulin is part of the formula for DKA. So you just need to keep a close eye on ketones.
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Will definitely do that, hoping I can get a good poke to double check him for that and his BG. He started hiding from me yesterday from all the poking and I don't want to traumatize him. I am still new to him, my house is completely new, and obviously the diabetes - it's a lot for him all at once.

I'll make a new thread after AMPS.
 
allicatmeow said:
Thank you so much. It feels relieving in a way that an experienced member would've chose 2U. I just felt like I needed to go with my gut for him and with reading so many threads of other people asking for help and seeing how few started as high as Smudge and how common 2U seems to be, I went with it.



I'm having trouble on mobile with colors, so I'll try to fix it on my computer this morning when I enter the rest of his morning stats. I fell asleep very quickly last night from exhaustion and I knew that I would, so I did not get a +4, but I left him plenty of food overnight at the direction of my vet because of the low numbers and adjustment. When I got up this morning he had cleaned his bowl overnight and was ready for more, but he will wait until another 2 hours so I could get a fasted AMPS.


Will definitely do that, hoping I can get a good poke to double check him for that and his BG. He started hiding from me yesterday from all the poking and I don't want to traumatize him. I am still new to him, my house is completely new, and obviously the diabetes - it's a lot for him all at once.

I'll make a new thread after AMPS.
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Poor boy! That is a lot of new stuff to adjust to in a short period of time. I hope y’all will be able to spend some quality time together too. And keep the treats coming! Hopefully you can use your new blood ketone meter soon too. But keep trying to get the urine test of not. Some people use a long handled ladle to catch a little urine— so that they don’t have to get right behind the cat while he is in the litter box (cat is wondering: “What are you weird humans doing anyway?)
 
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